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Background <p>The 2021 American Society of Clinical Oncology (ASCO) guidelines recommend neoadjuvant systemic therapy (NST) over upfront surgery for human epidermal growth factor receptor 2-positive (HER2+) and triple-negative breast cancers if node-positive or at least T1c. In practice, many clinicians use a 2-cm (T2) or node-positive threshold for NST, leaving controversy regarding management of clinically node-negative T1c HER2+ and triple-negative tumors. Accurate estimation of nodal status is therefore essential to guide management. This study evaluated the association between tumor size and nodal involvement in T1–T2 HER2+ and triple-negative tumors and assessed predictors of nodal positivity in T1c tumors.</p> Methods <p>A population-based retrospective cohort study was conducted using Institute for Clinical Evaluative Sciences (ICES) Ontario administrative data (2000–2019). The primary outcome was regional nodal positivity (N1–N3) stratified by tumor size (T1a–T2) and receptor subtype. Multivariable logistic regression identified independent predictors of nodal positivity in T1c tumors.</p> Results <p>The study analyzed 11,007 T1a–T2 cases including 1923 hormone receptor-negative (HR-)–HER2+ cases, 4542 HR+HER2+ cases, and 4542 triple-negative cases. Among T1a/b tumors, the nodal positivity rates ranged from 11 to 22% for HR–HER2+, 11–14% for HR+HER2+, and 7–11% for triple-negative tumors. Among T1c tumors, the rates were 32% for HR–HER2+, 26% for HR+HER2+, and 19% for triple-negative tumors. Among T2 tumors, the rates were 38% for HR–HER2+, 42% for HR+HER2+, and 30% for triple-negative tumors. Among T1c tumors, HR–HER2+ subtype and patient age younger than 50 years were independently associated with increased odds of nodal positivity.</p> Conclusions <p>Nodal positivity rates are substantial for T1–T2 HER2+ and triple-negative tumors, even for T1a/b tumors. Among T1c tumors, HR–HER2+ subtype and age of 50 years or younger independently predicted increased nodal positivity, supporting NST especially for these patients.</p>

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Association Between Tumor Size and Nodal Positivity for HER2+ and Triple-Negative Early-Stage Breast Cancer: A Population-Based Study

  • 期刊论文

  • 发表日期：

    2026年4月19日

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  • Yerin R. Lee,
  • Vasily Giannakeas,
  • Steven A. Narod,
  • David W. Lim

摘要

Background

The 2021 American Society of Clinical Oncology (ASCO) guidelines recommend neoadjuvant systemic therapy (NST) over upfront surgery for human epidermal growth factor receptor 2-positive (HER2+) and triple-negative breast cancers if node-positive or at least T1c. In practice, many clinicians use a 2-cm (T2) or node-positive threshold for NST, leaving controversy regarding management of clinically node-negative T1c HER2+ and triple-negative tumors. Accurate estimation of nodal status is therefore essential to guide management. This study evaluated the association between tumor size and nodal involvement in T1–T2 HER2+ and triple-negative tumors and assessed predictors of nodal positivity in T1c tumors.

Methods

A population-based retrospective cohort study was conducted using Institute for Clinical Evaluative Sciences (ICES) Ontario administrative data (2000–2019). The primary outcome was regional nodal positivity (N1–N3) stratified by tumor size (T1a–T2) and receptor subtype. Multivariable logistic regression identified independent predictors of nodal positivity in T1c tumors.

Results

The study analyzed 11,007 T1a–T2 cases including 1923 hormone receptor-negative (HR-)–HER2+ cases, 4542 HR+HER2+ cases, and 4542 triple-negative cases. Among T1a/b tumors, the nodal positivity rates ranged from 11 to 22% for HR–HER2+, 11–14% for HR+HER2+, and 7–11% for triple-negative tumors. Among T1c tumors, the rates were 32% for HR–HER2+, 26% for HR+HER2+, and 19% for triple-negative tumors. Among T2 tumors, the rates were 38% for HR–HER2+, 42% for HR+HER2+, and 30% for triple-negative tumors. Among T1c tumors, HR–HER2+ subtype and patient age younger than 50 years were independently associated with increased odds of nodal positivity.

Conclusions

Nodal positivity rates are substantial for T1–T2 HER2+ and triple-negative tumors, even for T1a/b tumors. Among T1c tumors, HR–HER2+ subtype and age of 50 years or younger independently predicted increased nodal positivity, supporting NST especially for these patients.